P1495 Boxwood Church RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR , DATE PERMIT
LOCATION �' -�: s . , (, r }; 1\ 1495
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p —MOBILE HOME E3BUSINESS
NO. BEDROOMS . NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual �f Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
House Trailer 800 Gal.
Two Bedroom House 800 Gal.
Three Bedroom House 900 Gal.
Four Bedroom House 1000 Gal.
INSTALLED BY
400 Sq. Ft.
600 Sq. Ft.
900 Sq. Ft.
1200 Sq. Ft.
_e Yy),O, Date 9-7-77
ly with all other applicable State and local regulations
77
DAVIE COUNTY HEALTH DEPARTMENT � (�
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
(7 04) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME �t��p�,.. Cc�� ��ns �✓c,-e CL�i� DATE ISSUED
ADDRESS +�� i PERMIT NO. ;
Explanation of charge
AMOUNT DUE SANITARIAN rn—" A
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.